Surgical Experiences in South Africa, 1899-1900: Being Mainly a Clinical Study of the Nature and Effects of Injuries Produced by Bullets of Small CalibreMakins, George Henry
History
Surgical Experiences in South Africa, 1899-1900: Being Mainly a Clinical Study of the Nature and Effects of Injuries Produced by Bullets of Small Calibre
Makins, George Henry
Gunshot wounds; South African War, 1899-1902; Surgery, Military
Reference to cases 7 and 9 as illustrating the possible spontaneous cure
of traumatic aneurisms is of great interest.
I saw a number of cases successfully treated by proximal ligature; also
a number where continuous improvement followed rest, and which were sent
home for further treatment. None of these demand any special mention.
One case of a very special nature, which terminated fatally, is of great
interest:--
(5) In a man wounded at Belmont the bullet entered the second
left intercostal space and was retained in the thorax. He was
sent directly to the Base and came under the care of Mr.
Thornton at No. 1 General Hospital, Wynberg. Signs of wound of
the lung developed in the form of haemoptysis and left
haemothorax. The left radial pulse was almost imperceptible.
The entry wound did not close by primary union, and three weeks
later an incision was made into the chest in consequence of the
presence of fever, progressive emaciation, and weakness.
Breaking down blood clot was evacuated: general improvement
followed, and the radial pulse increased considerably in
volume.
A fortnight later sudden severe haemorrhage occurred from the
external wound, and the man rapidly collapsed and died. At the
post-mortem a traumatic aneurism the size of an orange was
found in connection with an oval wound in the first portion of
the left subclavian artery which admitted the tip of the
forefinger.
This case is noteworthy as an illustration of the magnitude of an artery
which can be wounded without leading to rapid death from primary
haemorrhage, even when in communication with a serous sac, and still more
as emphasising the importance of weakening of the radial pulse as a sign
in connection with a wound of the upper part of the chest on the left
side. It is somewhat surprising that this sign was not marked in two
cases (Nos. 13 and 14, p. 140) recorded below, in which the innominate
and right carotid arteries respectively were probably perforated.
(6) _Traumatic popliteal aneurism._--Wounded at Modder River.
_Entry_ (Mauser), over centre of tibia 1 inch above the
tubercle. _Exit_, about centre of popliteal space. No
haemorrhage of any importance occurred from the wound, but there
was a typical haemarthrosis, which subsided slowly. Twelve days
after the injury a pulsating swelling the size of a hen's egg,
to which attention was drawn on account of pain, was noted in
popliteal space. The pulsation extended upwards in the line of
the artery some 3 inches. The limb was placed on a splint and
treated by rest, and a month later the aneurism had decreased
to one half its former size, the wall having greatly increased
in firmness. Pulsation was easily controlled by pressure above
the tumour; there was no thrill present, but a high-pitched
bellows murmur. The patient was sent home on February 1.
Public-domain text, read in full here on John Shaqi.
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